20180131CenturyLink Form 555.pdf

G,vR-T- t8-o I
Annual Lifeline Eligible Telecommunications Carrier Certification Form All carriers must complete all or portions
of all sections Form must be submitted to USAC and filed with the Federal Communications Commission
IMPORTANT: PLEASE READ INSTRUCTIONS FIRST
Deadline: Jonuary 31r- (Annuolly)
Does the reporting company have alfiliated ETCs? Yes @ No [O
Provide a list of all ETCs that are afiliated with the reporting ETC, using page 4 and additional sheets if necessary. Afiliation shall be
determined in accordance with Section 3(2) ofthe Communications Acl. That Section defnes "afiiliate" as "a person that (directly or indirectly)
owns or controls, is owned or contolled by, or is under common ownership or control with, another person." 47 U.S.C. S 153(2). See also 47
c.r.R. $ 76.1200.
Affiliated ETC's SAC I
lAffiliated ETC's Name
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472225 143002517
Study Area Code (SAC) Service Provider Identification Number (SPfN)
(An Eligible Telecommunications Carrier (ETC) must provide a certificationformfor each SAC through which it provides Lifeline semice).
2017 ID CenturyLink CenturyTel of ldaho lnc.
Recertification Year
N/A
State ETC Name
CenturyLink Inc.
DBA, Marketing, or Other Branding Name
(lf same as ETC name, list "N/A" Do 491leave blank)
Holding Company Name
(lJ same as ETC name, list "N/A" Do not leave blank)
ETCs Subject to the Non-Usage Requirements
All ETCs must complete the appropriate check-box. ETCs that do not assess and collec! a nonthly fee from their Lifeline subscribers are subject
to the non-usage requirements. ETCs subject to the non-usage requirements must indicate the number ofsubscribers de-enrolled by month ii
Section 1. ETCs that only assess afee but do not collect suchfees are subject to the non-usage requirements and must also indicate the number of
subscribers de-enrolled by month.
Is the ETC subject to the non-usage requirements? Yes @ No @
Ifyes, record the number ofsubscribers de-enrolledfor non-usage by month in Block Q below.
P a
Month Subscribers De-Enrolled for Non-Usage
January 0
February 0
March 0
April 0
May 0
June 0
July 0
August 0
September 0
October 0
November 0
December 0
Total Subscribers 0
For purposes of this filing, an officer is an occupant of a position listed in the article of incorporation, articles of formation,
or other similar legal document. An officer is a person who occupies a position specified in the corporate by-laws (or
partnership agreement), and would typically be president, vice president for operations, vice president for finance,
comptroller, treasurer, or a comparable position. If the filer is a sole proprietorship, the owner must sign the certification.
Initial Certificatiott All ETCs must complere this section
I certiff that the company listed above has certification procedures in place to:
A) Review income and program-based eligibility documentation prior to enrolling a consumer in the Lifeline program, and
that, to the best of my knowledge, the company was presented with documentation of each consumer's household
income and/or program-based eligibility prior to his or her enrollment in Lifeline; and/or
B) Confirm consumer eligibility by relying upon access to a state database and/or notice of eligibility from the state
Lifeline administrator prior to enrolling a consumer in the Lifeline program.
I am an officer of the company named above. I am authorized to make this certification for the Study Area Code listed
above.
JMAInitial
2
Minimum Service Level
I certify that the company listed above is in compliance with the minimum service levels set forth in the 47 CFR Section
s4.40{.
I am an officer of the company named above. I am authorized to make this certification for the SACs listed above.
Initial JMA
Annual Recertification
Do not leave empty blocks. Ifan ETC has nothing to report in a block, enter a zero.
Report the number oflifeline subscribers due for recertification by month (January-December)
A. Subscribers eligible for recertification by anniversary month
B. Subscribersde-enrolled priorto recertification attemptsC. Total number of subscribers ETC is responsible for recertifying (A-B)
Recertifi cation Methods
State of federal databaseD. Subscribers recertified through ETC access to state or federal database by anniversary month
the number of subscribers verified access to a state or federal database,
E. Name of the data source(s) used to veriff consumer eligibility:
ETC Direct ContactF. Subscribers contacted by ETC directly to recertif (You may also use this section to report subscriber initiated recertifications).
the number subscribers the ETC contacted to obtain recertification ofel
G. Subscribers who failed to recertiff through ETC direct outreach attempt
the de-enrolled due to or to the
3
Jan Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Year
Total
A.0 0 0 0 0 0 0 0 0 3 I I 21
B.0 0 0 0 0 0 0 0 0 0 0 1 1
C 0 0 0 0 0 0 0 0 0 3 I 8 20
Jan Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Year
Total
D.0 0 0 0 0 0 0 0 0 0 0 0 0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
F.0 0 0 0 0 00 0 0 0 0 0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
G.0 0 0 0 0 0 0 0 0 0 0 0
0
0
H. Subscribers who recertified through ETC direct outreach attempt
the number that recertified
Third Party
I. Subscribers whose eligibility was reviewed by state administrator, third party administrator, or USAC
the number of Lifeline subscribers contacted a state administrator, third administrator or USAC for the of recertification.
J. Name of third party administrator used to veriry subscriber eligibility:
USAC
K. Subscribers de-enrolled as a result ofa third party recertification attempt
the number of subscribers as a result of or to outreach lrom a state third or USAC.
L. Subscribers who recertified through a state administrator, third party administrator, or USAC's recertification effort
the number of subscribers that recertified from a state administrator.third administrator, or USAC
Certification:
Recertification Method: Database
I certiff that the company listed above has procedures in place to recertiS consumer eligibility by relying on a database. I
am an officer of the company named above. I am authorized to make this certification for the SAC(s) listed above.
Initial
4
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
H.0 0 0 0 0 0 0 0 0 0 0 0 0
Jan Feb Mar Apr Mav Jun Jul Aug sep Oct Nov Dec Year
Total
I.0 0 0 0 0 0 0 0 0 3 I 8 20
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
K.0 0 0 0 0 0 0 0 0 3 5 2 10
Jan Feb Mar Apr May Jun Jul Aug sep Oct Nov Dec Year
Total
L,0 0 0 0 00 0 0 0 0 4 6 10
Recertification Method: ETC
I certi$ that the company listed above has procedures in place to recertify the continued eligibility of all of its Lifeline
subscribers, and that, to the best of my knowledge, the company obtained signed certifications from all subscribers attesting
to their continuing eligibility for Lifeline. I am an officer of the company named above. I am authorized to make this
certification for the SAC(s) listed above.
Recertification Method: Third Party
I certifr that the company listed above has procedures in place to recertify consumer eligibility by relying on an
administrator. I am an offrcer of the company named above. I am authorized to make this certification for the SAC(s)
listed above.
1n111s1 JMA
No Subscribers
I certifr that my company did not claim federal low income support for any Lifeline subscribers for the current Form 555
data year. I am an officer of the company named above. I am authorized to make this certification for the SAC listed
above.
Initial
Signature Block
By signing below, I certify that the company listed above is in compliance with all federal Lifeline certification
procedures. I am an officer of the company named above. I am authorized to make this certification for the Study
Area Code (SAC) listed above.
Signed,
Jerry M. Allen. VP Revenues Jerry M. Allen, VP Revenues
Signature of Officer
[e-mail]
Email Address of Officer
Pam Hankins
Person Completing This Certification Form
Printed Name and Title of Officer
Jan 25,2018
Date
31 8-388-91 74
Contact Phone Number
p1 = 1a+K)N = (D+F+I)O = M/l\*lfi)
Total number ofsubscribers de-enrolled as
a result of recertilication
Total number of subscribers ETC is
responsible for recertifying
Percent ofsubscribers due for
recertifi cation who were de-enrolled
10 20 50.0%
5
Initial
Affiliated ETCs
SAC Name
r60138 United Telephone Company of New Jersey, Inc.
170209 United Telephone Company of Pennsylvania LLC, The
190254 Central Telephone Company of Virginia
190567 United Telephone Southeast, LLC (Virginia)
210341 Embarq Florida,Inc.
220356 Coastal Utilities, Inc.
230470 Carolina Telephone and Telegraph Company LLC
230471 Central Telephone Company (North Carolina)
230485 Mebtel,lnc.
240506 United Telephone Company of the Carolinas LLC
250298 Gulf Telephone Company, LLC
2s9788 CenturyTel of Alabama, LLC (Southern)
259789 CenturyTel of Alabama, LLC (Northern)
270434 CenturyTel of Evangeline, LLC
280458 CenturyTel of North Mississippi, Inc.
290552 CenturyTel of Adamsville, Inc.
290557 CenturyTel of Claibome, Inc.
290567 United Telephone Southeast, LLC (Tennessee)
290574 CenturyTel of Ooltewah-Collegedale, Inc.
300630 CenturyTel of Ohio,Inc.
300661 United Telephone Company of Ohio
31067 I CenturyTel Midwest - Michigan, Inc.
3 10689 CenturyTel of Upper Michigan, Inc
310702 CenturyTel of Michigan, Inc.
3 10705 CenturyTel of Northem Michigan, Inc.
320747 CenturyTel of Central Indiana,Inc.
320801 CenturyTel of Odon,Inc.
320832 United Telephone Company of Indiana, Inc.
330841 CenturyTel of the Midwest-Wisconsin, LLC (Cencom)
330857 CenturyTel of the Midwest-Wisconsin, LLC (Casco)
3308',77 CenturyTel of Fairwater-Brandon-Alto, LLC
330884 CenturyTel of Forestville, LLC
330895 CenturyTel of Wisconsin, LLC
330898 CenturyTel of Larsen-Readfield, LLC
3309 I 3 CenturyTelof Monroe County, LLC
330922 CenturyTel of the Midwest-Wisconsin, LLC (Northwest)
330924 CenturyTel of the Midwest-Kendall, LLC
33093 I CenturyTel of Southern Wisconsin, LLC
330934 CenturyTel of the Midwest-Wisconsin, LLC (Platteville)
330950 CenturyTel of Northwest Wisconsin, LLC
330956 CenturyTel of Northem Wisconsin, LLC
330959 CenturyTel of the Midwest-Wisconsin, LLC (Thorp)
330970 CenturyTel of the Midwest-Wisconsin, LLC (Wayside)
331155 Telephone USA of Wisconsin, LLC
331159 CenturyTel of Central Wisconsin, LLC
341057 Gallatin River Communications, LLC
Affiliated ETCs
SAC Name
351126 CenturyTel of Chester, Inc.
351274 CenturyTel of Postville, lnc.
3s5 141 Qwest Corporation (Iowa)
361445 CenturyTel of Minnesota, Inc.
36t456 Embarq Minnesota, Inc.
365142 Qwest Corporation (Minnesota)
371595 United Telephone Company of the West (Nebraska)
37s143 Qwest Corporation (Nebraska)
38s144 Qwest Corporation (North Dakota)
395145 Qwest Corporation (South Dakota)
401142 CenturyTel of Northwest Arkansas, LLC (Russellville)
401143 CenturyTel of Northwest Arkansas, LLC (Siloam Springs)
401144 CenturyTel of Central Arkansas, LLC
401705 CenturyTel of Arkansas, Inc
40t7tt CenturyTel of Mountain Home, Inc
401720 CenturyTel of Redfield, Inc.
401727 CenturyTel of South Arkansas, Inc.
4tt3t7 United Telephone Company of Eastem Kansas & United Telephone Comp
411842 United Telephone Company of Kansas
411957 Embarq Missouri, Inc. (Kansas)
42tt5t Spectra Communications Group, LLC
421957 Embarq Missouri, Inc.
429784 CenturyTel of Missouri, LLC (Central)
429785 CenturyTel of Missouri, LLC (Belle-Herman)
429786 CenturyTel of Missouri, LLC (Southem)
429787 CenturyTel of Missouri, LLC (Southwest)
442084 United Telephone Company of Texas,Inc
442101 CenturyTel of Lake Dallas, Inc.
442114 Central Telephone Company of Texas, Inc.
442117 CenturyTel of Port Aransas, Inc.
442140 CenturyTel of San Marcos,lnc.
455 l0 I Qwest Corporation (Arizona)
462185 CenturyTel of Eagle, Inc.
462187 The El Paso County Telephone Company
462208 CenturyTel of Colorado, Inc.
465102 Qwest Corporation (Colorado)
472223 CenturyTel of the Gem State, Inc. (Idaho)
472225 CenturyTel of Idaho, Inc.
475103 Qwest Corporation (Southern ldaho)
47st62 Qwest Corporation Q.{orthern Idaho)
482249 CenturyTel of Montana, lnc.
485 104 Qwest Corporation (Montana)
492274 CenturyTel of the Southwest, Inc.
495 I 05 Qwest Corporation (New Mexico)
505 107 Qwest Corporation (Utah)
51 1595 United Telephone Company of the West (Wyoming)
Affiliated ETCs
SAC Name
512299 CenturyTel of Wyoming, Inc.
515108 Qwest Corporation (Wyoming)
522400 United Telephone Company of the Northwest (Washington)
522408 CenturyTel of Washington, Inc. & CenturyTel of Inter-lsland, Inc.
522410 CenturyTel of Cowiche, Inc.
52516t Qwest Corporation (Washington)
532361 CenturyTel of Eastem Oregon, Inc.
s32361 CenturyTel of Oregon, Inc.
532400 United Telephone Company of the Northwest (Oregon)
535 I 63 Qwest Corporation (Oregon)
552223 CenturyTel of the Gem State, Inc. (Nevada)
552348 Central Telephone Company (Nevada)